225086 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 367648 Page 1 of 1
ONE CIVIC SQUARE LAUREN SIEFER CHECK AMOUNT: $6.00
CARMEL, INDIANA 46032 7511 CASTLETON FARMS W DR
INDIANAPOLIS IN 46256 CHECK NUMBER: 225086
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 6 . 00 REFUNDS AWARDS & INDE
ACTIVITY REFUND RECEIPT
Receipt# 1153764
Car-MCI 0 Clay Payment Date: 09/20/13
ParksAccreation Household#: 50557
Monon Community Center Lauren Siefer
Carmel IN 46032 i 7511 Castleton Farms W. Dr.
S E P 2 3 2013 Indianapolis IN 46256 Cell Ph:(317)225-9959
Imsiefer @gmail.com
Phone: (317)848-7275
Fed Tax ID#35-6000972
Enrollment Details
ROSTER CHANGE - Refund Of 6.00
Enrollee Name: Lauren Siefer Fees+Tax ., Discount Prev Paid Cur Paid Amount Due
Activity Number: 237021-01 Just Move 29.00' 0.00 29.00 0.00 0.00
Enrollment Date: 09/12/2013 (Enrolled)
I
Primary Instructor: CCPR Staff
Class Location: Multi-Purpose Room Class Dates: 09/14/2013 to 10/19/2013
Monon Community Cntr 9:OOA to 10:OOA
Sa
Carmel, IN 46032 Scheduled Sessions: 6
(317)848-7275
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 09/20/13 @ 10:53:04 by MML FEES ADJUSTED ON CHANGED ITEMS(+) 6.00-
NET AMOUNT FROM CHANGED ITEMS 6.00
TOTAL AMOUNT REFUNDED 6.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of=_> 6.00 Made By=_>REFUND FINAN With Reference=_>advanced request
All refunds are subject to State Board of Accounts procedures and may take 4-6 weeks to process. No cash refunds will be
i issued.
A'dAl"t-
Authorized Signature Date Authorized Signature Date
6�("50,L-r35 �q 06
Escape Day Passes are non-refundable.
Page# 1 of 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc
Payee
Purchase Order No.
Siefer, Lauren Terms
7511 Castleton Farms W Dr. Date Due
Indianapolis, IN 46256
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/20/13 1153764 Refund $ 6.00
Total $ 6.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
120
Clerk-Treasurer
Voucher No. Warrant No.
Siefer, Lauren Allowed 20
7511 Castleton Farms W Dr.
Indianapolis, IN 46256
In Sum of$
$ 6.00
ON ACCOUNT OF APPROPRIATION FOR
109 - MCC
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1096-50 1153764 4358400 $ 6.00 1 hereby certify that the attached invoice(s), or
hill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
4-Oct 2013
Signature
$ 6.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund